Psychopathological and cognitive manifestations associated with SARSCoV-2 virus infection

Author(s)

Rodolfo Furlan Damiano

• Document type: Doctoral Thesis
• Press: São Paulo.
• Institution: Universidade de São Paulo (USP). Faculdade de Medicina (FM/SBD)
• Defense date: 2023-05-10

Examining board members

Euripedes Constantino Miguel Filho; Ary Gadelha de Alencar Araripe Neto; Pedro Mario Pan Neto; Fabio de Rezende Pinna

• Advisor: Euripedes Constantino Miguel Filho; Orestes Vicente Forlenza

Abstract

Introduction: Preliminary studies with patients infected with the SARS-CoV-2 virus indicate involvement of different organs and systems, including the central nervous system (CNS). Changes in the CNS include acute and chronic manifestations involving clinical expressions of psychiatric, neurological or neuropsychiatric nature. In this present thesis, our objective is to characterize psychopathological and cognitive alterations after 6-11 months of SARS-CoV-2 infection. Objectives: a. To describe psychopathological and cognitive manifestations in patients after 6-11 months of SARS-CoV-2 infection; b. Identify baseline variables that may predict psychopathological and cognitive manifestations in patients after 6-11 months of SARS-CoV-2 infection; c. To investigate the association of smell and taste changes at baseline with psychopathological and cognitive manifestations in patients after 6-11 months of SARS-CoV-2 infection; d. Correlate the acute biological manifestations at baseline and after 6-11 months of SARSCoV- 2 infection, as measured by general blood tests and cytokine panel, and correlate them with psychopathological and cognitive manifestations at 6 to 11 months after. Methods: About 700 adult individuals with laboratory-confirmed diagnosis of COVID- 19 were evaluated. Such individuals had several data and biological markers collected during hospitalization, being subsequently evaluated multidisciplinary, from 6 to 11 months after discharge. At this time, biological materials were again collected. This thesis deals primarily with data collected from a structured psychiatric interview combined with several symptom assessment scales and a battery of neuropsychological tests in order to assess cognition. Results: The results of this thesis are presented in 3 articles. In Article 1, which involves objectives 1 and 2, we found: the diagnoses of \'depression\', \'generalized anxiety disorder\' and \'post-traumatic stress disorder\' were observed, respectively, in 8%, 15.5% and 13 .6% of the sample. Memory decline was subjectively reported by 51.1% of patients. Psychiatric or cognitive outcomes were not associated with any clinical variables related to the severity of the illness in the acute phase, nor with psychosocial stressors related to the illness. The results of article 2 refer to objective 3, that is: concomitant moderate/severe olfactory and gustatory loss during the acute phase of COVID-19 were significantly associated with worse performance in the word list memory task. Finally, we describe below the results of article 3, which refer to objective 4. The multivariate analysis found gender, age, ethnicity, education, comorbidity, frailty and physical activity significantly associated with general cognition. Bivariate analysis found that several biological markers (eg, G-CSF, IFN-alpha2, IL13, IL15, IL1-RA, EL1-alpha, IL45, IL5, IL6, IL7, TNF-Beta, VEGF, C-Reactive Protein and D -Dimer) at follow-up were significantly associated with general cognition. However, after a multivariate regression analysis (LASSO), such inflammatory markers and cytokines did not remain significantly associated with cognition. Conclusion: Our data suggest that mental disorders are frequent after 6-11 months of SARS-CoV-2 infection, notably depression, generalized anxiety and post-traumatic stress disorders. In addition to these, about half of the sample report memory decline. However, these findings were not associated with any clinical variable related to the severity of the disease in the acute phase, nor with psychosocial stressors related to the disease. On the other hand, we observed that chemosensory changes correlate with worse performance in memory tasks. Finally, our data did not support the hypothesis that inflammatory markers and cytokines (both in the acute and late phases) could predict or be associated with psychiatric or cognitive deficits in Long COVID (AU)

• FAPESP's process: 21/14379-8 - Psychiatric and cognitive manifestations associated with SARS-CoV-2 virus infection
• Grantee: Rodolfo Furlan Damiano
• Support Opportunities: Scholarships in Brazil - Doctorate (Direct)